HYDROMNIOS in pregnancy in management of hydromnias

hydromnios in complication of pregnancy in management of hydromniosw

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PRESENTATION ON
HYDROMNIOS
PESENTED BY
PRITI SINGH
B.Sc NURSING IV YEAR

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ANATOMY & PHYSIOLOGY
THE VOLUME OF AMNEOTIC FLUID IN A
NORMAL PREGNANCY IS ABOUT 1000 ML
AT 36 WEEKS, AND THIS AFTER IT SLOWLY
DECREASE. THE AMNIOTIC EPITHILUM IS
THE MAJOR SOURCE OF AMNIOTIC FLUID
THE FIRST HALF OF PREGNANCY THE
FOETAL SKIN ALLOWS DIFFUSSION & SO
THE AMNIOTIC FLUID IS ALMOST ON
EXTENSION OF THE FOETAL
EXTRACELLULAR FLUID.

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POLY HYDRAMNIOS
DEFINITION:
ITIS DEFINEDASA STATE WHERE LIQUOR AMNII
EXCEEDS 2000 ML .

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INCIDENCE
1 IN 1000 PREGNANCY.

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ETIOLOGY
1) FOETAL ANAMOLIES.
A)ANANCEPHALY
B)OPEN SPINABIFIDA
C)OESOPHAGEAL OR DUODENAL ATRESIA
D)FACIAL AND NECK MASSES
E)HYDROPS FETALIS
2)PLACENTA
CHORIOANGIOMA OF THE
PLACENTA
3)MULTIPLE PREGNANCY
4)MATERNAL
A)DIABETES
B) CARDIAC OR RENAL DISEASE

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CLINICAL TYPES
ACUTE (EXTREMELY RARE)
CHRONIC( COMMNEST)

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ACUTE POLYHYDRAMNIOS
POLYHYDRAMNIOS IS EXTREMELY RARE IT
USUALLY OCCURS BEFORE 20 WEEKS OF
PREGNANCY .IT IS USUALLY ASSOCIATED WITH
UNIOVULAR TWINS OR CHORIO ANGIOMA OF
THE PLACENTA.

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CLINICAL FEATURES
SYMPTOMS:
ABDOMINAL PAIN , NAUSEA & VOMITTING
SIGNS:
1)PATIENTS LOOKS ILL
2)ABSENCE OF FEATURES OF SHOCK
3)OEDEMA OF LEGS
4)ABDOMEN IS HUGELY ENLARGE

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DIFFRENTIAL DIAGNOSIS
1) ACCIDENAL HAEMORRAGE
2) RETROVERTED GRAVID UTERUS
3) HYDATIFORM MOLE

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TREATMENT
TO RELIEVE THE DISTRESS

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CHRONIC POLY HYDRAMNIOS
THE ACCUMULATION OF LIQUOR
IS GRADUAL

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CLINICAL FEATURES
SYMPTOMS:
1)DYSPNOEA
2)OEDEMA OF THE LEGS
3)VERICOSITIES IN THE LEGS OR VULVA.
4)HYPERTENSION & PROTIENURIA.

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ABDOMINAL EXAMINATION:
1) INSPECTION
ABDOMEN IS MARKEDLY ENLARGED LOOKS
GLOBULAR WITH FULLNESS AT THE FLANKS
THE SKIN IS TENSE , SHINY WITH LARGE STRIAE
2) PALPATION
 HEIGHT OF THE UTERUS IS MORE THE
PERIOD OF AMENORRHOEA.
GIRTH OF THE ABDOMEN ROUND THE UMBLICUS
IS MORE THEN NORMAL.
 FOETAL PARTS CANNOT BE WELL DEFINED.
3)AUSCULTATION
 FOETAL HEART SOUND IS NOT HEARD
DISTINCTLY.

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INTERNAL EXAMIONATION
THE CERVIX IS PULLED UP, MAY
BE PARTIALLY TAKEN UP OR AT
TIME DIALATED

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INVESTIGATION
1) SONOGRAPHY
2) RADIOGRAPHY
3) BLOOD
A)ABO& RH GROUPING
B)PPBS & GTT.
4) AMNIOTIC FLUID

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DIFFRENTIAL DIAGNOSIS
1) TWINS
2) MATERNAL ASCITES
3) PREGNANCY WITH HUG OVARIAN CYST

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COMPLICATION
MATERNAL
DURING PREGNANCY
1) PRE ECLAMPSIA
2) MAL PRESENTATION
3)PROM
4) PRE TERM LABOUR
5) ACCIDENTAL HAEMORRHAGE
DURING LABOUR
1) EARLY RUPTURE OF MEMBRANE
2) CORD PROLAPSE
3)UTERINE INERTIA
4)INCREASED OPERATIVE DILEVERY
5)RETAINED PLACENTA,PPH.
PUERPERIUM
1) SUB INVOLUTON
2) INCREASED PUPERAL MORBIDITY

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FOETAL
1)PRE MATURETY &
CONGENITAL ABNORMALITY
2)CORD PROLAPSE

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MANAGEMENT
SCHEME OF MANAGEMENT OF CHRONIC HYDRAMNIOS
NO FETAL ABNORMALITIES FETAL ABNORMALITIES
•HOSPITALIZATION
•PPBS
•ABO AND RH GROUP
•USG

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NO FETAL ABNORMALITIES
RESPONSIVE TO TREATMENT MATERNAL DISTRESS ++
•TO CONTINUE PREGENCY
•MANAGEMENT OF THE COMPLICA
TING FACTORS IF ANY
LESS THAN 37 WEEKS
AMANIOREDUCTION
PREGENCY 38 WEEK+
AMNIOREDUCTION
STABILIZING OXYTOCIN DRIP
ARM

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FETAL ABNORMALITY
TERMINATION OF PREGNANCY
IRRESPECTIVE OF GESTATION
CERVICAL RIPENING AND ARM

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OLIGOHYDROMINOS
DEFINITION
IT IS AN EXTREMELY RARE CONDITION WHERE
THE LIQUOR AMNII IS DEFICIENT IN AMOUNT TO
THE EXTENT OF LESS THEN 200 ML AT TERM

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ETIOLOGY
FETAL CHROMOSOMAL ANOMALIES
INTRUTERINE INFECTION
DRUGS-PG INHIBITOR ,AC INHIBITOR
RENAL AGENISIS
OBSTRUCTION OF THE URINARY TRACT
IUGR ASSOCIATED WITH PLACENAL
INCUFFICIENCY
POST MATURITY
AMNION NODOSUM

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DIAGNOSIS
UTERINE SIZE IS MUCH SMALLER THEN THE
AMENORRHOEA
LESS FETAL MOVEMENTS
MALPRESENTATION IS COMMON
SONOGRAPHY

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COMPLICATIOM
FETAL
ABORTION
CORSD COMPRESSION
HIGH FETAL MORTALITY
FETAL PULMONARY HYPOPLACIA
DEFORMITY DUE TO INTRA AMMNIOTIC
ADHESIONS OR DUE TO COMPRESSION

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PROLONG LABOUR DUE TO INERTIA
INCREASED OPERATIVE INTERFERENCE DUE
TO MALPRESENTATION
MATERNAL

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TREATMENT
PREMATURE RUPTURE OF THE MEMBRANE IS
COMMEN
LABOUR MAY BE PROTECTED AND TR4AND
CONTRACTION ARE MORE PAIN FULLAND
CONTRACTION ARE MORE PAIN FULL
FETAL DISTRESS OCCUR FREQUENTLY
BECAUSE OF FREQUENT ASSOCIATION OF
FETAL AMLFORMATION VAGINAL DELIVERY IS
FAVOURED

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